Elsevier

Vaccine

Volume 21, Issues 19–20, 2 June 2003, Pages 2564-2572
Vaccine

The cost-burden of paediatric pneumococcal disease in the UK and the potential cost-effectiveness of prevention using 7-valent pneumococcal conjugate vaccine

https://doi.org/10.1016/S0264-410X(03)00031-8Get rights and content

Abstract

We modelled the epidemiology and cost of pneumococcal disease in children in the UK and the cost-effectiveness of immunisation with 7-valent pneumococcal conjugate vaccine (PCV). We estimated the incidence of pneumococcal meningitis, pneumococcal septicaemia, all-cause pneumonia and all-cause otitis media (OM). We further estimated the impact of vaccination with associated costs and outcomes. Vaccine cost was £39.25 per dose with a £10 administration cost; vaccination schedule and efficacy were taken from a recent trial. We estimated that in each UK annual birth cohort there are 881,146 episodes of these infections and 149 deaths associated with pneumococcal meningitis, pneumococcal septicaemia or all-cause pneumonia and that PCV would prevent 54,384 episodes and 29 deaths. NHS cost per life year gained was estimated at £31,512, close to the limit at which PCV would be considered cost-effective.

Introduction

The capsulated gram-positive bacterium Streptococcus pneumoniae is an ubiquitous pathogen, affecting particularly the young and the elderly. It causes invasive pneumococcal disease (IPD) such as meningitis, septicaemia and bacteraemic pneumonia, and other forms of disease such as non-bacteraemic pneumonia and otitis media (OM). At least 90 distinct serotypes with pathological potential have been identified. In those under 5 years of age in the USA there are 17,000 cases of IPD and 200 deaths each year [1].

In adults and children 2 years of age and older a degree of protection may be conferred against 23 pneumococcal serotypes by polysaccharide vaccines. In those under 2 years of age polysaccharide vaccines have poor efficacy due to the inability of the immune system to mount an adequate response, and pneumococcal conjugate vaccines that are effective in this age group have been developed. The major burden of IPD in infants and children is represented by the serotypes in 7- or 9-valent conjugate vaccines [2], [3].

A large randomised, controlled double-blind safety, immunogenicity and efficacy study evaluated 7-valent pneumococcal conjugate vaccine (PCV) (Prevnar™/Prevenar™, Wyeth Pharmaceuticals) in the prevention of pneumococcal disease in the Northern California Kaiser Permanente Healthcare System (the NCKP study) [4], [5], [6]. This study randomised 37,868 children to vaccination with 7-valent PCV or control and found significant reductions in serotype-specific IPD, all-cause pneumonia and all-cause OM [4], [5], [6].

Introducing universal childhood vaccination with 7-valent PCV in the UK would result in substantial expenditure by the National Health Service (NHS). However, effective vaccination may offer economic as well as clinical benefits. In addition to the prevention of much of the considerable morbidity and mortality resulting from pneumococcal infections, successful vaccination might also reduce the use of antibiotics to manage disease, reduce antibiotic resistance, decrease GP visits and hospital admissions, reduce brain damage and other long-term sequelae, and reduce the cost of litigation arising from delayed or incorrect diagnosis of meningitis. Pharmacoeconomic analysis may be helpful to quantify such benefits and explore whether introducing vaccination would be a useful public health decision. An analysis of the cost-effectiveness of 7-valent PCV has been performed in the USA [7], but the findings of this analysis cannot be generalised to the UK due to differences in disease epidemiology, serotype prevalence and in medical costs and practice. The aim of this study was to evaluate the overall cost of paediatric pneumococcal disease in the UK and estimate the cost-effectiveness of a universal programme of immunisation with 7-valent PCV in infants and young children.

Section snippets

Methods

A model was developed in MS-Excel™ to estimate the incidence of four diseases (pneumococcal meningitis, pneumococcal septicaemia, all-cause pneumonia and all-cause OM) in a cohort of children from birth to 10 years of age. The cohort was divided into 6 months age bands, and infants under 6 months of age were further divided into those aged 0–2 and 2–6 months. We estimated the current annual number of infections in each age band, the reduction in events that would be associated with 7-valent PCV

Results

The model estimated that in the UK in each annual birth cohort (over the 10-year horizon) there are 578 cases of pneumococcal meningitis, 501 episodes of pneumococcal bacteraemia, 122,939 episodes of all-cause pneumonia, 757,128 episodes of all-cause OM and 149 deaths associated with IPD and all-cause pneumonia.

Table 1 shows case- and age-specific vaccine efficacy against each infection, and Fig. 1 shows the estimated numbers of infections for each time period considered by the model.

The model

Discussion

Our model estimated that a universal infant and early childhood immunisation programme with 7-valent PCV in the UK would reduce the incidence of pneumococcal infection, at a cost of £31,512 per life year gained. This finding is most sensitive to changing the incidence of and mortality from pneumococcal meningitis, the cost of brain damage, the cost of vaccination, and the incidence of and vaccine efficacy against pneumonia.

This evaluation has combined data from a number of sources to estimate

Conclusion

We have constructed a cohort model to evaluate the cost of pneumococcal infections in children and the cost-effectiveness of universal infant immunisation with 7-valent PCV. The model estimated the burden of disease to be substantial and suggests that the cost-effectiveness of 7-valent PCV vaccination is within acceptable limits. The findings are sensitive to the ability of vaccination to reduce the incidence and cost of pneumococcal meningitis and its long-term sequelae, and the cost of giving

Acknowledgements

Authors are thankful to Gerry Anderson (York University), Analytica (New York).

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